MR. JEREMY DE WAYNE LONG (NPI# 1831458561) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1831458561 |
| Entity Type | Individual |
| Full Name | MR. JEREMY DE WAYNE LONG |
| Credential | LMHC, LPC |
| Practice Address |
870 Hollywood Blvd West Melbourne FL 32904-7418 |
| Mailing Address |
630 Tejon Ave Sw Palm Bay FL 32908-7437 |
| Practice Telephone | 8004381772 |
| Practice Fax Number | 2623455562 |
| Mailing Telephone | 3214829492 |
| Enumeration Date | 2012-05-15 |
| Last Update Date | 2020-08-24 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 101YM0800X |
Counselor Specialization: Mental Health |
MH 11075 | FL | Behavioral Health & Social Service Providers |
| Y | 101YP2500X |
Counselor Specialization: Professional |
5617-125 | WI | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | 100057489 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 690 Friday Rd, Cocoa, FL 329263317 | 3216369941 | |
| W175n11120 Stonewood Dr, Germantown, WI 530224799 | 8004381772 | 2623455562 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568870012 | Jeremy Long | Pedorthist | 2503 Albion Ave, Baltimore, MD 21214-2526 | 2014-07-29 |
| 1447200381 | Jeremy P Long | Emergency Medical Technician, Basic | 1612 E Lamar Alexander Pkwy, Maryville, TN 37804-6206 | 2006-05-11 |
| 1073015426 | Jeremy Scott Long | Counselor | 295 Hospital St, Moulton, AL 35650-1210 | 2018-03-01 |
| 1568839140 | Jeremy Long | Physical Therapist | 4039 Route 219, Salamanca, NY 14779-9625 | 2015-08-30 |
| 1578871448 | Jeremy Sean Long | Rehabilitation Practitioner | 8665 W Flamingo Rd, Ste 2000, Las Vegas, NV 89147-8621 | 2010-09-14 |
| 1427067321 | Jeremy A Long | Internal Medicine | 301 W 6th Ave, Mc 3251, Denver, CO 80204-5182 | 2006-08-07 |
| Street Address |
870 HOLLYWOOD BLVD |
| City | WEST MELBOURNE |
| State | FL |
| Zip Code | 32904-7418 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447702956 | Wisconsin Lutheran Child & Family Service | Counselor | 870 Hollywood Blvd, West Melbourne, FL 32904-7418 | 2016-11-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063066512 | Shepherd's Heart Ministries | Counselor | 900 S Wickham Rd, Melbourne, FL 32904 | 2019-08-01 |
| 1588138663 | Nicholle C Rothengass | Physician Assistant | 2263 W New Haven Ave # 350, W Melbourne, FL 32904 | 2019-01-11 |
| 1114407020 | Natalie Havkin | Speech-Language Pathologist | 250 S Wickham Rd., Melbourne, FL 32904 | 2018-08-20 |
| 1184119299 | Marni B Simon | Speech-Language Pathologist | 565 Acacia Ave, Melbourne Village, FL 32904 | 2018-06-30 |
| 1821588625 | Walden Psychological Services, LLC | Psychologist | 3400 Willowwood Dr, Melbourne, FL 32904 | 2018-05-16 |
| 1598276271 | Donetta Gwin Reynolds | Early Intervention Provider Agency | 764 Triples Crown Lane, West Melbourne, FL 32904 | 2017-10-20 |
| 1598205221 | Marathon Health, LLC | General Practice | 2550 Wingate Boulevard, C/o Brevard Wellcare- South, West Melbourne, FL 32904 | 2017-02-28 |
| 1366875387 | Cancer Center of Melbourne LLC | Clinic/Center | 415 S. Wickham Rd., Melbourne, FL 32904 | 2013-08-13 |
| 1558704312 | Sandra Suzanne Borthwick | Social Worker | 569 Sylvia Rd, Melbourne, FL 32904 | 2013-04-11 |
| 1396983607 | Genesis | Skilled Nursing Facility | 2653 Reflections Pl, W. Melbourne, FL 32904 | 2009-01-23 |
| Find all providers in zip 32904 | ||||
| Taxonomy Code | 101YP2500X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Professional |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588954432 | Tammy Jean Bassile | Counselor | 1040 Olde Bailey Ln, West Melbourne, FL 32904-8000 | 2011-04-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235739038 | Lori Carol Helms | Counselor | 311 Us Highway 27 S, Sebring, FL 33870-2106 | 2020-10-29 |
| 1326646407 | Cheryl A Scott | Counselor | 3778 Suffolk Dr, Tallahassee, FL 32309-3005 | 2020-10-12 |
| 1134727274 | Inner Peace Counseling & Wellness | Counselor | 334 E Lake Rd Dept 280, Palm Harbor, FL 34685-2427 | 2020-10-12 |
| 1003413923 | Kristen Thompson | Counselor | 519 Briarwood Dr, Pensacola, FL 32506-6220 | 2020-10-04 |
| 1073120432 | Grow Mental Health Services, LLC | Counselor | 3585 Cedar Park Ln, Panama City, FL 32404-3824 | 2020-09-29 |
| 1528675162 | Ct Counseling, LLC | Counselor | 23051 Nw County Road 200a, Lawtey, FL 32058-4215 | 2020-09-28 |
| 1275140170 | Jerrai Rochelle Young | Counselor | 5111 Galloway Rd, Graceville, FL 32440-4309 | 2020-09-25 |
| 1770198129 | Jeanine Smith | Counselor | 7433 Se Marsh Fern Ln, Hobe Sound, FL 33455-7844 | 2020-09-12 |
| 1285248112 | Timothy Scott Mccann | Counselor | 7400 San Jose Blvd, Jacksonville, FL 32217-3430 | 2020-09-08 |
| 1164036059 | Dorelys Raquel Rivera | Counselor | 479 Basking Ridge Ct, Ocoee, FL 34761-1721 | 2020-09-08 |
| Find all providers with the same taxonomy | ||||
| City | WEST MELBOURNE |
| Zip Code | 32904 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.